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Concomitant Removal of Gastric Band and Gastric Bypass: Analysis of Outcomes and Complications from the ACS-NSQIP Database

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Abstract

Background

Conversion of laparoscopic adjustable gastric banding (LGB) to laparoscopic Roux-en-Y gastric bypass (LRYGB) is an established procedure. However, multiple reports have indicated higher morbidity and mortality rates associated with this operation, especially when performed as a single-staged procedure.

Purpose

We sought to compare mortality and morbidity of LRYGB vs. LRYGB with concomitant gastric band removal (LRYGB/LGBR).

Methods

Data from the American College of Surgeons’ National Surgical Quality Improvement Program (ACS-NSQIP) database was obtained for the time period of 2008 to 2014 using CPT codes for LRYGB and LGBR. Sepsis was the primary outcome measure with overall morbidity as a secondary outcome. Bivariate and multivariate analyses were carried out using SAS (Statistical Analysis System).

Results

During the study period, 64,866 patients had primary LRYGB and 1212 had LRYGB/LGBR. On bivariate analyses, mean operative time was lower for patients undergoing LRYGB rather than LRYGB/LGBR (132.88 ± 56.29 vs. 177.72 ± 70.21 min, p < 0.001). There was no statistically significant difference in the rate of postoperative mortality (0.16 vs. 0.08 %, p > 0.999), sepsis (0.78 vs. 0.74 %, p = 0.87), or other postoperative outcomes such as return to the operating room, wound infection, and venous thromboembolism. The odds ratio (OR) for sepsis remained not significant (OR = 0.74; 95 % confidence interval (CI) = (0.38–1.45)) after multivariate analysis.

Conclusion

LRYGBP/LGBR is not associated with a higher morbidity and mortality compared to LRYGB alone. The data implies that a one-step revisional procedure is appropriate when converting a failed gastric band to LRYGB.

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Authors and Affiliations

  1. Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon

    Elie P. Ramly, Bassem Y. Safadi, Hanaa Dakour Aridi, Rami Kantar & Ramzi S. Alami

  2. Clinical Research Institute, Biostatistics Unit, American University of Beirut Medical Center, Beirut, Lebanon

    Aurelie Mailhac

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  1. Elie P. Ramly
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  2. Bassem Y. Safadi
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  3. Hanaa Dakour Aridi
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Correspondence to Elie P. Ramly.

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The authors declare that they have no conflict of interest.

Ethical Approval

In accordance with the American University of Beirut’s guidelines (which follow the US Code of Federal Regulations for the Protection of Human Subjects), institutional review board approval was not needed or sought for this analysis because the data were collected as part of a quality assurance activity. For this type of study, formal consent is not required.

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Ramly, E.P., Safadi, B.Y., Aridi, H.D. et al. Concomitant Removal of Gastric Band and Gastric Bypass: Analysis of Outcomes and Complications from the ACS-NSQIP Database. OBES SURG 27, 462–468 (2017). https://doi.org/10.1007/s11695-016-2348-0

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  • DOI: https://doi.org/10.1007/s11695-016-2348-0

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